lesion, to mop out with pure carbolic acid, and to inject around and in the pustule carbolic acid (1:10) every six hours until the disease abates or toxic symptoms appear. The adherent eschar is subsequently gotten away by antiseptic poultices. Constitutional treatment is sustaining and stimulating.

Hydrophobia, Rabies, or Lyssa.-Hydrophobia is a spasmodic and paralytic disease due to infection through a wound with the virus from a rabid animal. The animal may be a dog, a cat, a wolf, a fox, or a horse. Roux estimates that about 14 per cent. of the people bitten by mad animals develop the disease. If the bite is on an exposed part, it is far more apt to cause rabies than if the teeth pass through clothing. Hydrophobia is always fatal. The saliva is the usual vehicle of contagion, but other fluids and tissues contain it, especially the brain and cord.

Symptoms.-The period of incubation of hydrophobia is from a few weeks to two years. The initial symptoms are mental depression, anxiety, headache, malaise, and often pain or even congestion in the cicatrix, which symptoms are quickly followed by a general hyperæsthesia, pharyngeal spasms, dyspnoea from laryngeal spasms, and constant attempts to expectorate thick mucus which forms because of congestion of the air-passages. Attempts at swallowing, as well as lights and noises, tend to bring on spasms, hence the fear of liquids. (there is spasm from attempts at swallowing or from thinking of the act). The entire body may be thrown into clonic spasms, but there is no tonic spasm. The mind is usually clear, although during the periods of excitement there may be maniacal furor with hallucinations which pass away in the stage of relaxation. The temperature is moderately elevated (101° to 103° or higher). This spasmodic stage lasts from one to three days, and the patient may die during this period from exhaustion or from asphyxia. If he lives through this

period, the convulsions gradually cease, the power of swallowing returns, and the patient succumbs to exhaustion in less than twenty-four hours, or he develops ascending paralysis which soon causes cardiac and respiratory failure.

In hydrophobia death is inevitable. Those cases in which it is alleged that recovery ensued were not true hydrophobia, but hysteria. Wood says that in hysteria, especially among boys, "beast-mimicry" is common, the sufferer snarling like a dog, and in the form known as "spurious hydrophobia," in which there may or may not be convulsion, there is a dread of water, emotional excitement, snarling, and attempts to bite the bystanders (in genuine hydrophobia no attempts are made to bite and no such sounds are uttered as are made by a dog).

Lyssa is separated from lockjaw by the spasms of the larynx and the absence of tonic spasms in the former, as contrasted with the spasms of muscles of mastication and the tonic spasms with clonic exacerbations of lockjaw.

Treatment. When a person is bitten by a supposed rabid animal, apply constriction above the wound if possible, excise, and burn with the hot iron. Send the patient to a Pasteur institute at once, that he may be given preventive inoculations of an emulsion made from the dried spinal cords of hydrophobic rabbits (attenuated virus). The value of this plan seems definitely established. In the paroxysm the treatment is palliative, and cannot be curative. Keep the patient in a dark, quiet room, relieve thirst by enemata, saturate with morphia, and in the paroxysms anæsthetize.

Glanders, Farcy, or Equinia.-Glanders is an infectious eruptive fever occurring in horses and communicable to man. If the nodules occur in a horse's nares, we call the disease "glanders;" if beneath his skin, it is termed "farcy." This disease is due to the bacillus of Löffler, and is communicated to man through an abraded surface or a mucous

membrane (Osler). The characteristic lesions are infective granulomata which in the nose form ulcers and under the skin develop abscesses.

Acute and Chronic Glanders. In acute glanders there is septic inflammation at the point of inoculation; nodules form in the nose, and ulcerate; there is profuse nasal discharge; the glands of the neck enlarge; there are fever and an eruption like small-pox on the face and about the joints (Osler). Acute glanders is always fatal. Chronic glanders lasts for months, is rarely diagnosticated, being mistaken for catarrh, and is often recovered from. Diagnosis is made by injecting a guinea-pig with the nasal mucus.

Acute and Chronic Farcy.-Acute farcy appears from a skin-inoculation; it begins as an intense inflammation, from which run out inflamed lymphatics that present nodules or "farcy-buds." Abscesses form. There are joint-pain and the constitutional symptoms of sepsis, but no involvement of the nares. Chronic farcy may last for months. In it nodules occur upon the extremities, which nodules break down into abscesses and eventuate in ulcers resembling those of tuberculosis.

Treatment. In treating this disease the point of infection is at once to be incised and cauterized. Open the abscesses, swab out with pure carbolic acid, and dress antiseptically. Give stimulants and nourishing diet. Diseased horses ought at once to be killed and their stalls torn out and purified.

Actinomycosis is an infectious disorder characterized by chronic inflammation, and is due to the presence in the tissues of the actinomyces or ray-fungus. This disease occurs in cattle (lumpy jaw) and in pigs, and can be transmitted to man, apparently by the food. At the point of inoculation (which is usually about the mouth) arises an infective granuloma, around which inflammation of connective tissue occurs, suppuration eventually taking place.

Symptoms.-The surgeon may see the lesion in the jaw (the enlargement resembling an abscess or sarcoma), on the tongue, and on the skin (resembling cutaneous tuberculosis). Pulmonary actinomycosis presents fever, cough, and wasting, the symptoms being usually one-sided and the fungus being found in the expectoration. Cerebral actinomycosis can occur. Osler says the disease is a chronic pyæmia with the fungus existing in the pus.

Treatment. The treatment consists in thoroughly extirpating the growth as we would a malignant tumor. Open, curette, and cauterize abscesses and sinuses. Remove dead bone. Iodide of potash has cured cases.

XV. SYPHILIS.

Definition.-Syphilis is a chronic infectious, and sometimes hereditary, constitutional disease. Its first lesion is an infecting area or chancre, which is followed by lymphatic enlargements, eruptions upon the skin and mucous membranes, affections of the appendages of the skin (hair and nails), "chronic inflammation and infiltration of the cellulo-vascular tissue, bones, and periosteum" (White), and, later, often by gummata. This disease is probably due to a microbe, but Lustgarten's bacillus has not been proved to be the one. One fact against its being the cause is its presence in the non-contagious late gummata. White quotes Finger in his assumption that syphilitic fever is due to absorption of ptomaines; that the eruptions of skin and mucous membranes in the secondary stage arise from local deposit and multiplication of the virus; that many secondary symptoms result from nutritive derangement caused by tissue-products passing into the circulation; that the virus exists in the body after the cessation of secondary symptoms;

and that it may die out or may awaken into activity, producing "reminders."

During the primary and secondary stages fresh poison cannot infect, and this is true for a time after the disappearance of secondary symptoms. Immunity in the primary stage is due to products absorbed from the infected area. Colles's immunity is that acquired by mothers who have borne syphilitic children, but who themselves show no sign of the disease. Profeta's immunity is the immunity against infection possessed by many healthy children born of syphilitic parents. Tertiary syphilitic lesions are not due to the poison of syphilis, but to tissue-products from the action of that poison. Tertiary syphilis is not transmissible, but it secures immunity.

Transmission of Syphilis.-This disease can be transmitted (1) by contact with the tissue-elements or virusacquired syphilis; and (2) by hereditary transmission-hereditary syphilis. The poison cannot enter through an intact epidermis or epithelial layer, and abrasion or solution of continuity is requisite for infection. Syphilis is usually, but not always, a venereal disease. It may be caught by infection of the genitals during coition, by infection of the tongue or lips in kissing, by smoking poisoned pipes, by drinking out of infected vessels, or by beastly practices. The initial lesion of syphilis may be found on the finger, forehead, eyelid, lip, tongue, cheek, palate, anus, nipple, etc. A person may be a host for syphilis, carry it, give it to another, and yet escape it himself (a surgeon may carry it under his nails, and a woman may lodge it in her vagina). Syphilis can be transmitted by vaccination with human lymph which contains the pus of a syphilitic eruption or the blood of a syphilitic person. Vaccine lymph, even after passage through a person with pox, will not convey syphilis if it is free from blood and the pus of specific lesions; it is not the lymph